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 Formulary Chapter 4: Central nervous system - Full Chapter
Notes:

CNS-related Prescribing Guidance

Please see our Prescribing Guidelines page for all prescribing guidance relating to this chapter.

CNS-related Shared Care Agreements

Please see our Shared Care Agreements page for all shared care agreements (SCAs) relating to this chapter.

 

 Details...
04.02.03  Expand sub section  Drugs used for mania and hypomania
 note 

Antipsychotic drugs – In an acute manic episode treatment with an antipsychotic drug may be required .Some atypical antipsychotics are also licensed as mood stabilisers (see BNF4.2.1)

04.02.03  Expand sub section  Benzodiazepines
04.02.03  Expand sub section  Antipsychotic drugs
04.02.03  Expand sub section  Carbamazepine
04.02.03  Expand sub section  Valproic acid to top
 note 

NICE CG185 Bipolar disorder: assessment and management April 18 update

Sodium valproate 
(Oral)
View adult BNF View SPC online
Formulary
Amber
  • Crushable tablet 100mg
  • E/C tablets 200mg, 500mg
  • m/r tablet 200mg, 300mg, 500mg (Category 2 MHRA)
  • m/r capsules 150mg, 300mg
  • LiquidSF 200mg/5ml 
  • Valproate must not be used in any woman or girl able to have children unless there is a pregnancy prevention programme (PPP) in place (see MHRA link).
  • Both semi‑sodium and sodium valproate are metabolised to valproic acid (also known as valproate), which is the pharmacologically active component.
  • Any of the available valproate preparations may be used as a mood stabliser in bipolar disorder (off label, but NICE recommended).

COVID-19 MHRA have issued guidance- see link below.

 

 

 
Link  MHRA Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) May 2020
Link  MHRA April 2019: Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
   
Valproic Acid (Depakote)
(Oral)
View adult BNF View SPC online
Formulary
Amber
  • Depakote® tablets 250mg, 500mg
  • Prescribe by brand name
  • May 2020: There are stock shortages of Depakote currently. AWP are using the brand syonell instead. There is also a different brand available called Belvo which can also be used. AWP have confirmed that this is a like for like switch and that primary care can switch patients from Depakote to an alternative brand during the shortages. Patients should be advised that the packaging and colour of the tablets are different, but the medicine is exactly the same.
  • Valproic acid – The semisodium salt (Depakote®) is licensed for the treatment of manic episodes associated with bipolar disorder.
  • Any of the available forms of valproate may be used off-label as a mood stabiliser.
  • Valproate must not be used in any woman or girl able to have children unless there is a pregnancy prevention programme (PPP) in place (see MHRA link)

COVID-19 MHRA have issued guidance- see link below. 

 
Link  MHRA Valproate Pregnancy Prevention Programme: temporary advice for management during coronavirus (COVID-19) May 2020
Link  3Ts Valproic Acid for the treatment of manic episode in bipolar disorder when lithium is contraindicated or not tolerated.
Link  MHRA April 2019: Valproate medicines and serious harms in pregnancy: new Annual Risk Acknowledgement Form and clinical guidance from professional bodies to support compliance with the Pregnancy Prevention Programme
   
04.02.03  Expand sub section  Lithium
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
click to search medicines.org.uk
Link to adult BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG
Blueteq
High Cost Drug Approval System

Traffic Light Status Information

Status Description

Red

RED - Hospital only to be prescribed by a specialist and supplied from secondary care ONLY throughout treatment.  

Amber

Amber medicines are considered suitable for GP prescribing following specialist initiation or recommendation.  

Amber with Shared Care

Shared Care - these medicines require specialist initiation and stabilisation. Ongoing division of responsibility for drug and disease monitoring between specialist and GP by a Shared Care Guideline (SCG). If no SCG in place status reverts to red.  

Green

These medicines are appropriate for initiation in both primary and secondary care. Prescribing is appropriate within licensed or local recommendations.  

Self

Suitable for patient to be directed to buy themselves  

Grey

Not currently used. We intend to include this TLS in future to highlight where a decision to use this medicine is under review.   

Black

Not currently used. We intend to include this TLS in future to highlight where a decision has been made by either or both the local or national NHS not to routinely commission this preparation for its licensed indications. Do not prescribe.  

Red Specialist Centre

Not currently used. We intend to include this TLS in future to highlight where this medicine and indication is ONLY available through a Specialist Centre according to a NICE Highly Specialised Technology or NHSE Specialised Commission Circular / Policy.  

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